| NPI | 1053404665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 4127-125) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WA LH00009180) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2022-07-14 |